The Limits of Choice: Abortion and Assisted Dying

Michelle Oberman compares abortion and assisted dying and argues that focusing on the ‘right to choose’ risks ignoring the social and economic factors that shape and constrain our choices.

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I’ve watched the trend toward legalizing physician assistance in dying with a vague sense of alarm. My peers, healthy and wealthy, are puzzled by my response. How is this different from abortion, they ask? You’re pro-choice on abortion, so why wouldn’t you be for assisted dying?

Here’s my problem: As much as I support reproductive rights, I am weary of the rhetoric of ‘choice’ as it applies to great swaths of women who have abortions. I’ve spent the past six years studying abortion in the United States, and in countries like El Salvador where abortion is completely banned. The more I’ve learned about why many women have abortions, the less I see abortion as a choice. Abortion is often a coerced response to desperate circumstances.

When we focus on the question of choice – framing the issue as one of individual liberty – we ignore entirely the social and economic factors that shape and constrain choice. Such constraints lead many women to undergo abortions they might otherwise deeply prefer to avoid. The most common reason that women give for seeking an abortion is financial. It is expensive to have a baby, to pay for day care, to feed, clothe, and house a child. For marginally-employed women, having a baby necessarily means plunging themselves and their families deeper into poverty.

We’ve spent decades fighting over abortion, yet we have done little to offset the economic pressures that compel some women to have one. There is a quip that some people believe that life begins at conception and ends at birth. We are all guilty of focusing on the period of pregnancy while ignoring the realities of what awaits a woman who gives birth.

This is the entrenched reality of our broken abortion discourse. As we embrace the practice of assisted dying, we should guard against making a similar mistake. Yet, it appears that we are going down the same road. We are invoking language of individual liberty and of honoring patients’ choices. But what are we doing to make sure these choices are not coerced by the absence of resources?

What troubles me is not so much that we’re changing the way we die. Rather, it’s that we’re doing so without acknowledging, let alone taking responsibility for, the circumstances that might lead a person to want to die.

What are the social policies that will shape when and whether individuals will seek help in dying? Fear of pain is a common reason people give for seeking assisted dying. Thus, any country that embraces assisted dying has an obligation to ensure that everyone has access to state of the art medical care and to medicines that can alleviate pain and provide true comfort for those facing chronic, incurable illness.

This is far from the case today, at least in the United States. Public policies determine what it costs to grow old in optimal health and comfort. Huge numbers of individuals who reach 80 or 90 years of age have no life savings, no supplemental health insurance, no adult children living nearby, and no access to assisted living facilities. Will society work to offset the incentive such a person might otherwise have to seek a quick, painless death? If not, is it accurate to cast that person’s request for assisted dying as a personal choice?

The issue goes beyond resources for those who are already nearing natural deaths. Because we frame the issue as one of choice, it will be difficult to limit the right to seek assisted dying. It may be only a matter of time until we see more permissive legislation like that in the Netherlands and Belgium, where lethal prescriptions can be administered to patients with dementia, to children, to those with incurable depression, and to those who are simply ‘tired of living.’ After all, the right to assisted dying is predicated upon a desire to avoid suffering, and suffering comes in many shapes and sizes.

My point is not that assisted dying should be forbidden in such cases. My point is that before going down that road we must ensure we are doing all in our power to enable meaningful choices. We have failed to do that with regard to abortion; let us not repeat that mistake with regard to assisted dying.

In embracing assisted dying, we are undoing centuries-old laws and norms governing our relationship with dying and with killing. By talking only about autonomy and rights, we commit the grave mistake of assuming we have no collective responsibility to create a world in which life itself is truly an option.

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Michelle Oberman is a Professor at Santa Clara University School of Law and author of, Her Body, Our Laws: On the Front Lines of the Abortion War from El Salvador to Oklahoma (forthcoming Beacon Press, 2018).

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